Emergency Department Models of Care 2012 - NSW Health

3.7 Fast trackED Senior Assessment StreamingTriageRegistration2 hoursFast trackWhat is the model?Why use the model?Fast track is a dedicated area in the ED to treat ambulant, non-complex (single systemproblem) patients who can be discharged within < 2 hours. Triage streams patients into theFast Track using a pre-determined inclusion/exclusion fast track criterion.Fast Track zones aim to increase ED throughput by:■■■■■Expediting the care of ambulatory patients with less urgent complaints (Al Darrab et al,2006; Considine et al 2010)Diverting the care of patients who meet particular clinical criteria through a separatestream in the ED (Ieraci et al, 2008)Using a geographically dedicated area staffed by dedicated senior medical and nursingstaff (Considine et al 2010)Dedicated senior medical and nursing staff working to optimise the performance of fasttracksystems as they have the ability to make timely treatment and disposition decisionswith minimal consultation (Considine et al 2010)Providing care that is standardised and targeted to specific conditions and injuries.Fast Track zones provide an alternative option to treat non-complex patients in a timelymanner, reducing long waiting times for minor problems.A study by Ieraci et al (2008) demonstrated a reduction in the mean waiting time for fasttrack patients from 55 minutes to 32 minutes and a reduction in the mean treatment timefrom 209 to 191 minutes.Key principles ■ Expedite the journey for less-urgent / non-complex patients■ Use dedicated staff (Ieraci 2008)■■■■■■■■Operating hours should reflect high demand periods (Considine et al 2010) – in some EDs,demand may be sufficient for Fast Track to operate as 24-hour seven day per weekservice.Uses quarantined space where patients are treated in a dedicated area by dedicated staffCommence treatment earlyStrict inclusion and exclusion criteria supported by business rulesClinical protocols that promote early initiation of nursing careRapid access to appropriate imaging and pathologyPatients with a single system problem that can be discharged in < 2 hoursEasy access to specialty outpatient, GP and community care referral services.Models of Emergency Care NSW HEALTH PAGE 31